Posted On Dec 23, 2019

Department of

Manipal Hospitals

gynaecology scan centre

What is Endometriosis?

The tissue that lines the inside of the uterus is called endometrium. Endometriosis is a disorder where this tissue grows outside the uterus rather than inside it.  This is usually confined to the lower abdomen, or the pelvic region, such as the ovaries, lymph nodes, peritoneum and the fallopian tubes, but in rare cases, may spread beyond the pelvic organ.  This displaced endometrial tissue will grow, thicken and break down in the same way it would have inside the uterus. But in this condition, since the displaced tissue cannot be expelled outside the uterus during menstruation, it becomes trapped, irritate the surrounding tissues, and cause physical symptoms such as pain and adversely affect other bodily functions like blocking the fallopian tubes.

What causes Endometriosis?

There are some theories about why endometriosis happens.

  • One possible explanation is that some of the blood and tissues may travel out of the uterus through the fallopian tubes and into the abdominal cavity when the woman has her period. This in turn may lead to retrograde menstruation.
  • Cells outside the uterus may metamorphose into the same kind of cells that lines the interior of the uterus.
  • During a surgical procedure such as a cesarean section, a woman may end up getting some endometriosis cells attached to the abdominal incision, due to which she is affected by endometriosis in the scar from the surgery.

What are the symptoms of Endometriosis?

The symptoms of Endometriosis include:

  • Pain in the pelvic region before and during the periods.
  • Pain during intercourse
  • Infertility
  • Severe menstrual cramps and pain during menstruation
  • Pain during bowel movements and urination
  • Excessive bleeding between the periods
  • Periods lasting longer than 7 days
  • Lower back pain occurring during menstrual cycle
  • Fatigue
  • Nausea and vomiting
  • Diarrhea
  • Constipation

Diagnosis of Endometriosis

There is no single test for diagnosing endometriosis; instead, the doctor performs a variety of tests for an accurate diagnosis:

  • Pelvic Exam: The doctor manually feels your abdomen for any cysts or scars behind the uterus.
  • Ultrasound: A device known as transducer is either inserted into the vagina (transvaginal ultrasound) or pressed against the abdomen (abdominal ultrasound) in order to create images of the reproductive organs. This can help identify cysts associated with endometriosis, although it does not conclusively prove whether the person has this condition.
  • Laparoscopy: In this method, the doctor makes a small incision in the abdomen near the navel and inserts a small viewing device, also known as laparoscope, to examine the endometrial tissue and also take samples of the tissue (biopsy). Depending on the nature of the lesions, the particular stage of endometriosis can be ascertained.
    • Stage 1: Small and isolated lesions on the ovary
    • Stage 2: Mild lesions and several shallow implants on the ovary and pelvic lining
    • Stage 3: Moderate or deep lesions with clear adhesions
    • Stage 4: Multiple, severe lesions on ovary and pelvic lining, and may also be present on the fallopian tubes and bowels.

Endometriosis Treatment

Currently, there is no cure for endometriosis, but the available treatment methods are aimed at reducing the severity of the symptoms and managing any complications.

  • Medications: This is the most conservative treatment option. Non-steroidal, anti-inflammatory medications such as ibuprofen and naproxen can help in relieving the pain associated with endometriosis. Some oral contraceptive pills and gonadotrophin-releasing hormone (GnRH) analogs are other examples of commonly used medicines.
  • Hormones: Some therapies like taking supplemental hormones can help provide relief from the pain and slow down the growth of the endometrial tissue. For example, hormonal contraceptives, Intrauterine device and drugs like danazol are commonly used. However, this is not a permanent form of treatment.
  • Surgery: Conservative surgery is performed to remove the endometrial growths without damaging the reproductive organs. It is usually done in cases where the woman wants to get pregnant, experiencing severe pain or for whom hormonal treatments are not working. This surgery may be done laparoscopically or through traditional abdominal surgery. A drawback of surgical method is that there is a good chance of recurrence of endometriosis.
  • Hysterectomy: This is done in severe cases of endometriosis, and involves removal of the uterus, cervix and the ovaries. This is a treatment of last resort where the patient hasn’t responded to other treatments.

There are some complementary treatment options which can be done at home to manage the symptoms. Regular physical activity like walking can help slow down the rate of progression. Avoiding coffee can also help, as caffeine can aggravate the symptoms of endometriosis.

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